First name:
* must provide value
Provide your legal name as it appears on official or government-issued documents (passports, licenses etc.)
Last name:
* must provide value
Provide your legal name as it appears on official or government-issued documents (passports, licenses etc.)
Date of birth (MM-DD-YYYY):
* must provide value
Today M-D-Y *According to RPCI policy, persons under the age of 14 years old are not allowed to train in a research laboratory
Citizenship:
* must provide value
U.S. citizen
Permanent resident
Foreign
Place of permanent residency:
* must provide value
United States
Commonwealth of Puerto Rico
Northern Mariana Islands
Guam
American Samoa
Trust Territory of the Pacific
Current enrollment:
* must provide value
High School
College/University
Nursing BSN
Medical School
PA School
Current year in school:
* must provide value
First Year
Second Year
Third Year
Fourth Year
Graduated
Home/landline phone number:
* must provide value
Personal/cell phone number:
* must provide value
School/work/daytime phone number:
If different from personal phone number.
Personal/permanent email address:
* must provide value
School email address:
* must provide value
If available.
Mailing/Campus housing address: Dormitory or Housing Complex
If applicable.
Mailing/Campus housing address: Number and Street
* must provide value
Mailing/Campus housing address: City/Town
* must provide value
Mailing/Campus housing address: State
* must provide value
Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Mailing/Campus housing address: ZIP code
* must provide value
Residential address: Number and Street
* must provide value
Residential address: City/Town
* must provide value
Residential address: State
* must provide value
Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Residential address: ZIP code
* must provide value
Indicate your choice to be offered a funded internship:
* must provide value
I wish to be considered for a stipend-supported internship ONLY and will not accept a non-funded internship.
I wish to be considered for a stipend-supported internship, but I am willing to accept a non-funded internship.
The following demographic information is requested on a voluntary basis. It is being collected for purposes of tracking demographics of the applicant pool ONLY and is NOT considered in the review of applications.
African American
American Indian or Alaskan Native
Asian (originating from Far East Asia, South East Asia, Indian Subcontinent)
Pacific Islander (including Fijian, Hawaiian, Samoan)
Latino (including Mexican American; not Puerto Rican)
Puerto Rican
White, Anglo, Caucasian American (non-Hispanic)
Male
Female
Are you the first generation in your family to attend a graduate medical program?
Yes
No
Highest level of education anyone in your immediate family attended
High school
Two-year community college
Four-year undergraduate
Graduate school (including medical school)
Highest degree level obtained by anyone in your immediate family:
High School Diploma
Associate's Degree
Bachelor's Degree
Master's Degree
Doctoral Degree (ie MD, PhD etc)
Is anyone in your immediate family in a scientific or health-related profession?
Yes
No
Name of school:
* must provide value
If applicable.
School address: City/Town
* must provide value
School address: State
* must provide value
Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Anticipated graduation date (MM/DD/YYYY):
* must provide value
Today M-D-Y
Current degree sought:
* must provide value
DO
MD
PA
Other
Other degree:
* must provide value
Special Program (i.e. Honors):
If applicable.
Cumulative OVERALL GPA:
* must provide value
Round to two decimal places. Include grades from the most recent semester.
What scale is used to determine your GPA?
* must provide value
4.0
3.0
100%
Other
Other Scale:
* must provide value
Does your school rank students based on overall GPA?
* must provide value
Yes
No
Provide your class rank. Use only the numerical ranking, for instance a "1" instead "1st" or "first." If indicating a percentile rank, use only the integer. For instance, "10" for top ten percentile.
Your class rank:
* must provide value
Enter numerical value.
Indicate if this is a "rank" or "percentile":
* must provide value
Percentile Rank
Number of students in your class:
* must provide value
Enter numerical value.
Provide scores for any standardized tests you have taken.
Enter score if applicable.
Enter score if applicable.
Enter score if applicable.
Life Science MCAT/DAT score:
Enter score if applicable.
Physcial Science MCAT/DAT score:
Enter score if applicable.
List SCIENCE-related co-curricular activities in which you participate(d) by category below. For multiple items in a field (i.e. more than one award) name each in most recent chronological order and separate by a comma. If none, type "None."
Awards and achievements:
* must provide value
Type "None" if there are none.
Society and club memberships:
* must provide value
Type "None" if there are none.
Officer/leadership positions:
* must provide value
Type "None" if there are none.
Have you participated in previous research internships or have prior research experience?
* must provide value
Yes
No
Select the type(s) of research experience(s) in which you participated:
* must provide value
You may choose more than one.
Other type of research experience:
* must provide value
Provide the information below about your MOST RECENT research experience
Project Title/topic:
* must provide value
Research supervisor:
* must provide value
Site of experience:
* must provide value
Name of institution or university
Site of experience: Department
If applicable.
Have you given scientific talks or presentations?
* must provide value
Yes
No
Type(s) of presentation(s) given:
* must provide value
You may select more than one.
Provide the following information about your MOST RECENT scientific talk/presentation.
Presentation title/topic:
* must provide value
Site of talk/presentation:
* must provide value
Institution, university or conference name
Site of talk: City
* must provide value
Site of talk: State
* must provide value
Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Year of talk:
* must provide value
Select the statement that best describes your current career goals:
* must provide value
I am unsure of my future career goals.
I plan on pursuing a medical/allied health profession.
I plan on pursuing a medical/allied health profession specializing in oncology.
I plan on pursuing a combined medical and scientific profession.
I plan on pursuing a combined medical and scientific profession specializing in oncology/cancer research.
Based on the education and career goals you have selected, write a personal statement which answers the following three questions in paragraph form (LIMIT TO 300 WORDS):
(1) What is your motivation towards the educational and career goals you have chosen?
(2) How will an internship in a cancer research laboratory or clinic help you to determine or achieve your education and career goals?
(3) What knowledge, skills and insight do you hope to attain from a cancer research experience?
* must provide value
LIMIT TO 300 WORDS
First choice mentor:
* must provide value
Abel, Ethan Bakin, Andrei Buxbaum, Nataliya Chandra, Dhyan Das, Gokul Ebos, John Gelman, Irwin Guru, Khurshid Liu, Song Nastiuk, Kent Nwogu, Chukwumere Shafirstein, Gal Singh, Anurag Tang, Li Wang, Eunice Yeary, Karen Zhang, Jianmin
Second choice mentor:
* must provide value
Abel, Ethan Bakin, Andrei Buxbaum, Nataliya Chandra, Dhyan Das, Gokul Ebos, John Gelman, Irwin Guru, Khurshid Liu, Song Nastiuk, Kent Nwogu, Chukwumere Shafirstein, Gal Singh, Anurag Tang, Li Wang, Eunice Yeary, Karen Zhang, Jianmin
Third choice mentor:
* must provide value
Abel, Ethan Bakin, Andrei Buxbaum, Nataliya Chandra, Dhyan Das, Gokul Ebos, John Gelman, Irwin Guru, Khurshid Liu, Song Nastiuk, Kent Nwogu, Chukwumere Shafirstein, Gal Singh, Anurag Tang, Li Wang, Eunice Yeary, Karen Zhang, Jianmin
Fourth choice mentor:
* must provide value
Abel, Ethan Bakin, Andrei Buxbaum, Nataliya Chandra, Dhyan Das, Gokul Ebos, John Gelman, Irwin Guru, Khurshid Liu, Song Nastiuk, Kent Nwogu, Chukwumere Shafirstein, Gal Singh, Anurag Tang, Li Wang, Eunice Yeary, Karen Zhang, Jianmin
First Choice Mentor (PA Students)
* must provide value
Guru, Khurshid Liu, Song Shafirstein, Gal Yeary, Karen Zhang, Jianmin
Second Choice Mentor (PA Students)
* must provide value
Guru, Khurshid Liu, Song Shafirstein, Gal Yeary, Karen Zhang, Jianmin
Third Choice Mentor (PA Students)
* must provide value
Guru, Khurshid Liu, Song Shafirstein, Gal Yeary, Karen Zhang, Jianmin
Fourth Choice Mentor (PA Students)
* must provide value
Guru, Khurshid Liu, Song Shafirstein, Gal Yeary, Karen Zhang, Jianmin
Provide the following contact information for a reference. This should be a science professor, research supervisor or advisor or other professional who can assess your science abilities. Be sure to request permission from the individual to serve as a reference.
An email containing a link to an on-line recommendation form will be sent to your reference. To ensure timely receipt of the form: (1) be sure that the contact information you provide for your reference is accurate and (2) inform your reference that they should add the "roswellpark.org" domain to their safe-list in their email account so that it is not spam-filtered.
First name:
* must provide value
Last name:
* must provide value
Academic/employment title:
* must provide value
Place of employment:
* must provide value
School/official email address:
* must provide value
School/office phone number:
* must provide value
First name:
* must provide value
Last name:
* must provide value
Academic/employment title:
* must provide value
Place of employment:
* must provide value
School/official email address:
* must provide value
School/office phone number:
* must provide value
How did you learn about the program?
* must provide value
You may select more than one choice.
If you are accepted into the program and your permanent residence is outside commuting distance to Buffalo NY, will you require housing?
* must provide value
Yes
No
Laboratory Coat Size:
* must provide value
2X-Small X-Small Small Medium Large X-Large 2X-Large
Accepted students receive a program monogrammed laboratory coat on loan for the summer.
Answer the following question regarding your application:
* must provide value
I authorize every school that I have attended to release all requested records and recommendations to Roswell Park Cancer Institute for the purpose of evaluating my application to the summer educational program. I also authorize employees of Roswell Park Cancer Institute to contact, in confidence, my current and former schools should they have questions about the information submitted on my behalf.
Answer the following question to waive the right to review your recommendation and supporting application materials (This is done to assure candid responses from y our recommenders)
* must provide value
I waive my right to review all recommendations and supporting documents submitted by me or on my behalf as part of the application to the summer educational program. I understand that I will not be able to access these recommendations through Roswell Park Cancer Institute or through my current school.
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